Insurance & LiensQuestion 571 of 1605
The amount a doctor or hospital may bill the workers' compensation insurer for treating an injured worker is governed primarily by:
a.The Official Medical Fee Schedule (OMFS) adopted by the Division of Workers' Compensation
b.The doctor's customary cash rates
c.Whatever the employee's group health plan would pay
d.Negotiation case-by-case between the worker and provider
Explanation
Labor Code §139.6 directs the Administrative Director of the Division of Workers' Compensation to adopt and update an Official Medical Fee Schedule. Providers treating WC patients are generally limited to the OMFS rates, regardless of their usual cash or group-health pricing.
Law Reference: Labor Code §139.6Practice all 1605 questions free — no signup required.
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